WiHPCA News

By Hoven Consulting  – WiHPCA’s lobbying firm

• Legislative Council Study Committee on Occupational Licenses - Update

The Legislative Council Study Committee on Occupational Licenses held its first hearing on August 2, 2022, at the Capitol building in Madison. The committee first received an overview from the Legislative Council Staff, then a briefing from the Legislative Fiscal Bureau, a briefing from the National Conference of State Legislatures (NCSL), and finally by the Wisconsin Department of Safety and Professional Services (DSPS).

Many of the questions for NCSL centered on the licensing process, interstate compacts, universal licensing, and reciprocal licensing. Questions for DSPS centered on staffing, the time required for licensure, issues with applications, legal reviews (crimes and ordinance violations) and additional barriers to timely and efficient license.

Following the testimony, study committee members discussed the following items:

• Duplication of background checks on applicants (credentials and hiring company)
• Insurance requirements for practice
• Number of applications being processed and approved (DSPS Stats)
• Reciprocal license, universal license and compacts

This committee’s next meeting will occur on September 27, 2022, in Madison.  For more information about this committee, please visit the committee’s website. 

• August 9 Primary Election Update

The following is a summary of the results of the August 9 primary election:

• As expected, Democratic Lt. Governor Mandela Barnes won his primary and will face incumbent Republican U.S. Senator Ron Johnson in November. 
• In the most contested race for the U.S. House of Representatives in Wisconsin, incumbent Democratic State Senator Brad Pfaff won the Democratic primary and will face Republican Derrick Van Orden in western Wisconsin’s Third Congressional District.  Retiring U.S. Rep. Ron Kind (D) currently represents this district.

• By a margin of 5 percent, Tim Michels prevailed in the Republican gubernatorial primary over former Lieutenant Governor Rebecca Kleefisch and will face incumbent Democratic Governor Tony Evers in November. 

• In the race for Lieutenant Governor, State Rep. Sarah Rodriguez of Brookfield won the Democratic primary and State Senator Roger Roth of Appleton prevailed in a crowded Republican primary. 
• In the State Assembly, all incumbent Republicans facing primary challengers won their respective races, including Assembly Speaker Robin Vos of Rochester, who faced Adam Steen.  Adam had received the endorsement of former President Donald Trump in the closing weeks of the primary campaign over concerns related to the 2020 election. 
• In the State Senate, incumbent Republican Senator – and Senate Majority Leader – Devin LeMahieu of the Sheboygan area prevailed against two opponents.  Also, incumbent Republican Senator Van Wanggaard of Racine won his race against a primary opponent. 

·       New Marquette Law School Poll Released on August 17

On August 17, Marquette Law School released a new statewide political poll.  The following poll findings may be of interest.

Gubernatorial Race

This poll, which was conducted from August 10-15 – after the August 9 primary election – asked Wisconsin voters their preference for governor:

• Governor Tony Evers (Democrat):  45%
• Tim Michels (Republicans):  43%
• Joan Beglinger (Independent):  7%

The August poll also asked respondents if they approved or disapproved of how Governor Evers is handling his job.  His approval rating was 47%, his disapproval rating is 45%, and 8% did not have an opinion. 

U.S. Senate Race

This poll asked Wisconsin voters about their preferred candidate for this year’s U.S. Senate race.  The poll found the following:

• Lt. Governor Mandela Barnes (Democrat):  51%
• U.S. Senator Ron Johnson (Republican):  44%

The poll also asked respondents if they have a favorable or unfavorable opinion of Lt. Governor Mandela Barnes and U.S. Senator Ron Johnson.  The poll found the following:

• Lt. Governor Mandela Barnes (Democrat)
• • Favorable:  37%
  • Unfavorable:  22%
  • Haven’t heard enough:  30%
  • Don’t know:  11%

• U.S. Senator Ron Johnson (Republican)
• • Favorable:  38%
  • Unfavorable:  47%
  • Haven’t heard enough:  9%
  • Don’t know:  6%

Issue Polling

The August poll also asked questions regarding various issues.  One of the questions asked whether the state is headed in the right direction or not.  The poll found the following: 

• Right direction:  35%
• Wrong track:  56%
• Don’t know:  9%

This poll also asked how Wisconsinites felt about certain topics.  Allowed responses:  very concerned, somewhat concerned, not too concerned, and don’t know.

• Inflation:  94% were either very concerned or somewhat concerned
• Crime:  88% were either very concerned or somewhat concerned
• Public Schools:  88% were either very concerned or somewhat concerned
• Gun Violence:  87% were either very concerned or somewhat concerned
• Taxes:  85% were either very concerned or somewhat concerned
• Abortion Policy:  80% were either very concerned or somewhat concerned
• Climate Change:  69% were either very concerned or somewhat concerned
• Illegal Immigration:  68% were either very concerned or somewhat concerned
• Coronavirus:  55% were either very concerned or somewhat concerned

Grassroots advocacy is the most powerful tool WiHPCA has at its disposal to shape public policy – and building relationships with lawmakers is the most important aspect of advocacy. In effort to capitalize on our greatest advocacy resource – our membership – WiHPCA has unveiled our Coffee Conversations with Legislators advocacy program.

The initiative is designed to help connect members with their local legislators. Under the program, the WiHPCA Government Affairs Team will set-up in-district meetings between WiHPCA members and state lawmakers who represent them in the Legislature. These meetings, which can be located at your facility, or a local coffee shop provide a tremendous opportunity for WiHPCA members to build or strengthen their relationships with local legislators and to educate them on hospice and palliative care and on policy issues important to hospice professionals and their patients.

WiHPCA encourages all members to participate in this critical grassroots advocacy program. Please click here for more information on the program. If you’re interested in participating in the program, contact the WiHPCA office at wihpca@badgerbay.co if you’re interested in participating.

A year and a half after initiating our quarterly meetings with the Division of Quality Assurance (DQA) at the Wisconsin Department of Health Services, on June 28, we finally held our first in-person meeting. To be more accurate, it was a hybrid meeting with a handful of WiHPCA members attending in-person at the DHS hosted meeting, with the rest of the participants joining virtually. Regardless, it was great to be in the same room with DQA staff, as it led to a much more productive conversation.

As usual, DQA provided participants with a review and discussion of numerous key issues, including survey deficiencies, complaint topics, and the number of new hospice applications. During the 2^nd quarter of the year (March to May), DQA reported the agency conducted 19 hospice surveys and six recertifications surveys. They also fielded 15 complaint intakes, of which eight were investigated, and four were substantiated. As a result, there were three immediate concerns stemming from the substantiated complaints. They fell in the following categories: 1.) Patient Rights; 2.) Nursing Services; and 3.) Quality of Care and Treatment

The next quarterly meeting is scheduled for September. Stay tuned for more details and the opportunity to register. We certainly encourage participation from all WiHPCA members, as these meetings continue to provide invaluable information, regulatory guidance, and best practices insights from DQA.

In the meantime, CLICK HERE to visit the DHS Hospice Statistics webpage, which includes vital data for the calendar year through 2021.

WiHPCA is happy to remind members about and provide links to the latest articles and information from Hospice News and other publications:

·       Hospices Could Face Legal Risks When COVID PHE Ends

By Holly Vossel | July 21, 2022

The recently extended COVID-19 public health emergency (PHE) will not last forever. When it does expire, hospices need to be aware of potential legal risks. The U.S. Department of Health & Human Services (HHS) once again extended the COVID-19 PHE until Oct. 6. While the agency has the option to keep extending the emergency, hospices may start seeing additional scrutiny, particularly in regards to telehealth utilization and the Provider Relief Fund (PRF). Read more…

·       NAHC’s Dombi: ‘Workforce Shortage Affects All of Society’

By Holly Vossel | July 25, 2022

The home-based care workforce shortage has social and economic ripple effects, according to Bill Dombi, president of the National Association of Home Care & Hospice (NAHC). Demand is outstripping supply for home-based care, said Dombi at the NAHC Financial Management Conference in Las Vegas. Home-based care providers are rejecting upwards of roughly 30% of referrals because providers lack the clinicians to sustain the volume, he said. Read more…

·       Sequestration’s Return Creating a ‘Tsunami of Pain Points’ for Hospices

By Holly Vossel | July 15, 2022

The return of sequestration is adding to the financial storms brewing in hospice, as providers contend with rising costs of delivering patient care, inflation and lackluster reimbursement. Providers are increasingly concerned about their ability to sustain their businesses through choppy waters, calling on regulators to step up support. Read more…

·       Why Some Referred Patients Never Make It to Hospice

By Jim Parker | July 8, 2022

Hospice referrals appear to be going up. But many patients who get the referral never receive the care due to low health literacy and social determinant of health factors. Among patients who received inpatient discharge instructions indicating hospice, nearly 1 in 10 did not enroll within 30 days of leaving the hospital, according to recent research from Trella Health. The company used data from the last quarter of 2020 and the third of 2021. Read more…

Hospice News, which is part of the Aging Media Network, is a leading source for news and information covering the hospice industry.

• The National Hospice and Palliative Care Organization (NHPCO) and Hospice Action Network (HAN) recently sent a letter to Congress, joined by organizations representing a broad coalition of the hospice and palliative care community, to request protection of access to high-quality hospice care for Medicare beneficiaries. The letter asks congressional leaders to call on the Centers for Medicare & Medicaid Services (CMS) to make changes to the proposed payment rate increase for Fiscal Year 2023 (FY23). A more sufficient rate would reflect the unprecedented demands and costs that hospice providers and programs are facing across the country. CLICK HERE to read the full letter.
  
  
• Earlier this month, the Biden Administration and the U.S. Department of Health and Human Services (HHS) announced it has extended the COVID-19 public health emergency (PHE) through October 13, 2022. The PHE provides special access to health insurance and offers key flexibilities on telehealth and reporting deadlines. The Biden Administration has long agreed to give 60 days’ notice warning if the PHE will not be extended again.

• Last month, the Advancing Telehealth Beyond COVID-19 Act of 2021 was introduced in Congress to extend key telehealth waivers introduced during the pandemic. The legislation includes some of the most significant waivers introduced by the CMS since the COVID-19 pandemic began, including the elimination on geographical restrictions on Medicare coverage for telehealth services. It would also specifically extend hospice telehealth flexibilities – the option to hold face-to-face visits prior to recertification for the hospice benefit via telehealth, and for hospice patients to attend telehealth visits from home – through the end of 2024. CLICK HERE to contact your Members of Congress through the Hospice Action Network and urge them to support the Advancing Telehealth Beyond COVID-19 Act of 2021.
  
  
• At the June 28 DQA-WiHPCA quarterly meeting (see more information below), the regulatory agency invited WiPHCA to review the state’s hospice interface document, the findings of which will be used to update the document. If you are interested in assisting with this important project and use your experience and expertise to review the hospice interface document, please contact the WiHPCA office at wihpca@badgerbay.co.

By Hoven Consulting  – WiHPCA’s lobbying firm

• Uniform Death Reporting Standards Study Committee – First Meeting

The Legislative Council’s Study Committee on Uniform Death Reporting Standards held its first public hearing in Madison on Monday, July 18 at 10:00AM.  The meeting features presentations by the state Department of Health Services, including from the State Registrar at the State Vital Records Office, a representative from a mental health organization and a children’s health organization, as well as the Chief Medical Examiner of Fond du Lac County.  A list of committee members, the full meeting agenda, as well as written presentations may be viewed on the legislature’s website.  

• DHS Announces Annual Adjustment of Health Care Provider Fees for Patient Health Care Records

Effective on the first day of each July, the Wisconsin Department of Health Services publishes an updated schedule of the maximum fees that health care providers may charge for producing patient medical records.  These fees are based on the consumer price indices for the prior two calendar years.  The fees vary based on the number of pages and the type of file provided (e.g., paper documents, microfiche, x-rays, etc.).  This fee schedule may be viewed on the Legislature’s website. 

• DSPS Secretary Dawn Crim Leaving Evers Administration

Earlier in July, Wisconsin Department of Safety and Professional Services (DSPS) Secretary Dawn Crim announced that she will be leaving the Evers Administration on August 1, 2022.  The State Medical Examining Board and the State Board of Nursing are housed within DSPS, which also processes nearly all occupational license applications in Wisconsin, including licenses for physicians, nurses and other health care professionals.  Earlier this year, DSPS implemented an online platform for health care occupational license applications.  The agency will transition the remaining occupational licenses that they handle to their online platform in the future. 

Governor Evers has announced that DSPS Assistant Deputy Secretary Dan Hereth will be the DSPS Secretary-designee upon Secretary Crim’s departure. 

• State Supreme Court Decision on Local Health Officer Authority

On July 8, the Wisconsin Supreme Court ruled that local health officials have the statutory power to issue public health orders without first getting permission from elected officials in their respective jurisdictions.  This case started out as a challenge from Dane County businesses against the authority of Public Health of Madison and Dane County (PHM&DC) related to COVID-19 emergency orders that PHM&DC Director Janel Heinrich issued.  These plaintiffs contended that the only way that these emergency orders could be enforced would be for the Dane County board to vote to approve them.  The Wisconsin Supreme Court ruled – with a 4-3 vote – that existing state statute includes the authority for local health officers to issue such emergency orders without the approval of elected officials in their respective jurisdiction.  The full decision may be viewed here. 

• Governor Announces Over $5 Million in Healthcare Workforce Grants

On June 23, Governor Evers announced the award of more than $5 million in Workforce Innovation Grant Program funds to assist with healthcare workforce challenges in Wisconsin.  Specifically, up to $4.9 million will be awarded to the Wisconsin Community Action Program Association (WISCAP), which is the statewide organization that represents 16 community action non-profit organizations throughout our state.  These organizations focus on assisting low-income households.  With these funds, WISCAP will assist in paying for low-income individuals to receive training and education to become healthcare workers.  Up to $376,000 will go to the University of Wisconsin at Green Bay to assist in expanding the nursing faculty in order to train up to 152 nursing students. 

Grassroots advocacy is the most powerful tool WiHPCA has at its disposal to shape public policy – and building relationships with lawmakers is the most important aspect of advocacy. In effort to capitalize on our greatest advocacy resource – our membership – WiHPCA has unveiled our Coffee Conversations with Legislators advocacy program.

The initiative is designed  to help connect members with their local legislators. Under the program, the WiHPCA Government Affairs Team will set-up in-district meetings between WiHPCA members and state lawmakers who represent them in the Legislature. These meetings, which can be located at your facility, or a local coffee shop provide a tremendous opportunity for WiHPCA members to build or strengthen their relationships with local legislators and to educate them on hospice and palliative care and on policy issues important to hospice professionals and their patients.

WiHPCA encourages all members to participate in this critical grassroots advocacy program. Please click here for more information on the program. If you’re interested in participating in the program, contact the WiHPCA office at wihpca@badgerbay.co if you’re interested in participating.

WiHPCA is happy to remind members about and provide links to the latest articles and information from Hospice News, the National Association for Home Care and Hospice, and other publications:

·         New Research Proposes ‘Sustainable’ Palliative Care Payment Model

By Holly Vossel | June 24, 2022

A group of researchers have modified a proposed reimbursement system for palliative care that they say would improve access for patients and make the service more lucrative for providers. The American Academy of Hospice and Palliative Medicine (AAHPM) in 2017 proposed that the U.S. Department of Health & Human Services’ (HHS) consider the Patient and Caregiver Support for Serious Illness (PACSSI) model.

·         MedPAC: Streamline Alternative Payment Models

By Jim Parker | June 22, 2022

As hospices explore greater participation in alternative payment models, the Medicare Payment Advisory Commission (MedPAC) is urging Congress to reduce and restructure those programs. Hospice providers have been eying APMs emerging for the Center for Medicare & Medicaid Innovation (CMMI). These models represent an entry point to value-based reimbursement, as well as a means to support additional business lines such as palliative care, PACE and other services. Read more…

·         US Senators Call on CMS to Boost Palliative Care Resources

By Jim Parker | June 21, 2022

A bipartisan group of nine U.S. Senators have written to U.S. Centers for Medicare and Medicaid Services (CMS) Administrator Chiquita Brooks-LaSure, calling for a payment model demonstration designed to support greater access to palliative care. The lawmakers urged the Center for Medicare & Medicaid Innovation (CMMI) to develop a dedicated community-based palliative care benefit, which has been a longstanding goal for providers and industry advocacy groups. Read more…

·         Care Coordination Key to Hospices’ Success in Value-Based Care

By Jim Parker | June 17, 2022

As more health care reimbursement migrates towards value-based payment models, providers will need to master the art of care coordination. Seriously ill patients can easily fall through the cracks in a fragmented health care system, leading to poorer outcomes and costly hospital stays and emergency department visits. Closing these gaps is a rising priority in payment model demonstrations by the Center for Medicare & Medicaid Innovation (CMMI). Read more…

·         Staff Poaching on Rise Amid Hospice Labor Shortage

By Holly Vossel | June 14, 2022

As hospices continue to duke it out in the labor market, more providers are contending with competitors poaching their employees. A number of hospice leaders have told Hospice News that poaching is becoming a greater source of tension in the industry’s recruitment and retention ground war. This often comes with promises of higher wages, more extensive benefit packages or sign-on bonuses. Read more…

·         Quality Measures: Will the CMS Hospice Care Index Actually Work?

By Jim Parker | June 1, 2022

The U.S. Centers for Medicare & Medicaid Services (CMS) designed the Hospice Care Index (HCI) to paint a picture of care processes that occur between a patient’s admission and discharge, but as currently designed it may not be an effective measure of quality. Payers and referral partners are paying closer attention to hospices’ performance on publicly reported quality measures, which as of Fiscal Year 2022 includes the HCI. Each provider receives a single numerical score ranging from zero to 10, based on a set of quality indicators. Read more…

Hospice News, which is part of the Aging Media Network, is a leading source for news and information covering the hospice industry. National Association for Home Care and Hospiceis the largest professional association representing the interests of chronically ill, disabled, and dying Americans of all ages and the caregivers who provide them with in-home health and hospice services.

The latest Marquette University Law Poll, which was released on June 22, shows that Wisconsin’s top political races – for governor and the U.S. Senate – are extremely close less than a month and a half from the primary and a little more than four months from the November general election.

In the Republican primary for governor, which will be held on Aug. 9, former Lt. Gov. Rebecca Kleefisch is in a dead heat with construction magnate Tim Michels. The poll results showed 27 percent of Republican respondents favored Michels, while 26 percent backed Kleefisch. Other GOP candidates did not break the 10 percent mark.

GOP Governor Primary:

• Michels – 27%
• Kleefisch – 26%
• Businessman Kevin Nicholson – 10%
• State. Rep Tim Ramthun – 3%
• Other or Undecided – 34%

The poll also showed that all GOP candidates trailed incumbent Wisconsin Governor Tony Evers (D) in projected head-to-head general election matchups:

• Evers: 47% — Kleefisch: 43%
• Evers: 48% — Michels: 41%
• Evers: 48% — Nicholson: 40%
• Evers: 51% — Ramthun: 34%

In the Democratic primary for U.S. Senate, the winner of which will face incumbent U.S. Senator Ron Johnson (R), current Lt. Gov. Mandela Barnes led the pack with 25 percent support from Democratic poll respondents. Milwaukee Bucks executive Alex Lasry came in at 21percent, while Wisconsin State Treasurer Sarah Godlewski received 9 percent support.

• Barnes – 25%
• Lasry – 21%
• Godlewski – 9%
• Outagamie County Exec Tom Nelson – 7%
• Other or Undecided – 38%

In addition, the poll also showed Barnes, Godlewski, and Nelson all leading Sen. Johnson in potential general election matchups:

• Barnes: 46% — Johnson: 44%
• Godlewski: 45% — Johnson: 43%
• Nelson: 44% — Johnson: 43%
• Johnson: 45% — Lasry: 42%

• The National Partnership for Healthcare and Hospice Innovation (NPHI) recently sent a letter to House Speaker Nancy Pelosi (D-CA), Senate Majority Leader Chuck Schumer (D-NY), Senate Minority Leader Mitch McConnell (R-KY), and House Minority Leader Kevin McCarthy (R-CA) urging Congress to take immediate action to prevent the one percent Medicare payment cut set to go into effect on July 1, 2022. With hospices already facing potentially devastating financial pressures, the NPHI request stresses the negative consequences of the cut and strongly encourages Congress to avert the reduction before it’s too late. NPHI was joined by the National Hospice and Palliative Care Organization (NHPCO), National Association for Home Care and Hospice (NAHC), and LeadingAge in sharing these sentiments with Congressional leaders. The full letter can be found here.

• U.S. Senators Tammy Baldwin (D-WI) and Shelley Moore Capito (R-WV) have reintroduced the Palliative Care and Hospice Education and Training Act (PCHETA), a bipartisan bill to grow, improve and sustain the palliative and hospice care workforce to keep pace with patients’ needs and to help improve the well-being of Americans with life-threatening illnesses and their families. A one pager on the bill is available here. Full text of the legislation is available here. WiHPCA members can help advance this important legislation by contacting their members of Congress and urging them to support the proposal through the NHPCO’s Hospice Action Network. The network is completely automated. You simply need to enter your name, address, and limited contact information and the Network takes care of the rest.
• Earlier this month, NPHI released their submitted comments to CMS regarding the FY23 Hospice Payment Rate Update proposed rule [fact sheet, full rule]. NPHI's full comment letter can be found here. The final rule including responses from CMS to comments and questions raised by stakeholders is expected to be released later this summer.